Washington

As the nation waited anxiously to hear the President's Jan. 28 State of the Union Address, administration officials provided a sneak preview of Bush's 2004 budget proposals. Health care highlights included a $1.75 billion program to help disabled elderly people make the transition home from an institution, a plan to restructure Medicare, and a boost in funding to address chronic diseases such as asthma and obesity.

Early in 2001, Bush announced a New Freedom Initiative, designed to help disabled Americans integrate more fully into society. To further this initiative, the 2004 budget will include a five-year, $1.75 billion program that will encourage states to revamp long-term care systems to provide more cost-effective choices between institutional and community-based care options.

“The President and I are committed to changing policies that unnecessarily confine people with disabilities in institutional settings,” said Tommy Thompson, secretary of the U.S. Department of Health and Human Services. “We went to work with the states and the disability community to change old programs and develop new ones that will serve people with disabilities in the settings that work best for them.”

The Medicare landscape could look very different in 2004, if Congress approves Bush's reform proposal. Top administration officials told The New York Times last month that the proposal includes three options for beneficiaries: the traditional fee-for-service plan, without a prescription drug benefit; a health-maintenance-organization plan, with a drug benefit; and a private plan, with “enhanced fee-for-service benefits,” including a drug benefit. Under the third option, Medicare would charge copayments for home health care, the officials said.

Although reticent to comment on a proposal that is not yet final, the Alexandria, Va.-based American Association for Homecare assured HomeCare that the association would oppose any such copayment.

Another budget proposal would include $100 million to prevent diabetes, obesity and asthma, by encouraging healthy lifestyles. “To truly stem the epidemic of preventable diseases that threaten too many Americans, we need to move from a health care system that treats disease to one that avoids disease through wiser personal choices,” Thompson said, explaining that these funds would pay for state and community initiatives.

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